title: Decision-making, reward-seeking behaviors and dopamine agonist therapy in restless legs syndrome.
abstract: OBJECTIVE
  To assess whether the frequency of impulse control disorders (ICDs), addictive behaviors, impulsivity, and impairment of decision-making task performance under ambiguous and risky conditions were present in patients with restless legs syndrome (RLS) and whether changes could be related to dopaminergic medications.
  
  
  METHODS
  Case-control prospective study.
  
  
  METHODS
  Academic Sleep Disorders Center.
  
  
  METHODS
  Of the 149 participants, there were 39 who were drug free with primary RLS, 50 who were taking dopamine agonists (DA), and 60 control subjects. Participants were assessed with a clinical interview screening for ICDs, augmentation syndrome, impulsivity, depression, and addictive behaviors. All participants completed two decision-making tasks, one under an ambiguous condition (Iowa Gambling Task) and the other under a risky condition (Game of Dice Task). Drug-free patients with RLS underwent 1 night of polysomnography recording.
  
  
  RESULTS
  Seventy percent of patients were treated with pramipexole (median dose, 0.36 mg), and 30% with ropinirole (median dose, 0.75 mg). Median duration of DA intake was 11 mo (range, 1-72 mo). No differences were found on impulsivity scores, ICDs, and substance addiction between drug-free patients or those taking DA, or control subjects. Patients with RLS reported more depressive symptoms than control subjects, but without differences between patients taking or not taking DA. Drug-free and treated patients demonstrated reduced performances on the Iowa Gambling Task but not on the Game of Dice Task compared to control subjects, with no differences between patients taking medications and those who were not. No association was found between decision-making task performances, or polysomnographic and clinical variables.
  
  
  CONCLUSIONS
  Impulse control disorders, impulsivity, and substance addiction were infrequent in drug-free patients with restless legs syndrome or those treated with a low dose of dopamine agonists. However, patients with restless legs syndrome, either drug free or taking dopamine agonists, had preferences toward risky choices on the Iowa Gambling Task, which led to negative consequences in the long run, a condition potentially leading to further development of impulse control disorders.
authors.affiliation: Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, France ; INSERM U1061, Montpellier, France ; Centre de Référence National sur les Maladies Rares (Narcolepsie, Hypersomnie Idiopathique, Syndrome de Kleine-Levin), France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bayard
authors.forename: Muriel Croisier
authors.initials: MC
authors.lastname: Langenier
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D052160:Benzothiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D003657:Decision Making / Q000187:drug effects*; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005715:Gambling / Q000209:etiology; D006801:Humans; D007175:Impulsive Behavior / Q000209:etiology; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D000077487:Pramipexole; D011446:Prospective Studies; D012148:Restless Legs Syndrome / Q000188:drug therapy* / Q000523:psychology; D012201:Reward; D011795:Surveys and Questionnaires
chemical_list: D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D000077487:Pramipexole
keywords: Game of Dice Task; Iowa Gambling Task; Restless legs syndrome; decision-making; dopamine agonist; impulsive compulsive disorders